Post-partum state

Sleep deprivation

Dopamine agonist (amphetamines/L-dopa)

Antidepressants

Stroke or brain injury

Jet lag (especially West to East)

Severe life stress

State of increased energy without psychotic symptoms or need for hospitalizatoin

Less intense form of mania

17

What type of bipolar diagnosis is made in patients with hypomania?

Bipolar II

18

What symptoms result in classification of mania, not hypomania?

Paranoia

Delusions

Hallucinations

19

Patients are often (aware/unaware) of their mania?

Unaware (feel too good to be an illness)

Family, friends, or the legal system bring it to their attention

20

What is characteristic of Bipolar Course I?

Rapid cycling (4 or more mood episodes per year)

21

What is characteristic of Bipolar Course II?

Mainia/depression may last for 4-8 months and remit spontaneoulsy

May go years without episodes

Depression may be chronic (last years)

22

What is characteristic of Bipolar Depression 1?

"Atypical depression"

Excessive sleeping

Increased eating

Suicide risk

Teen atypical depression may be first sign of bipolar disorder

23

What is characteristic of Bipolar Depression 2?

Often "atypical" features (increased sleeping, eating)

May be seasonal (winter depressions, etc.)

May have psychosis (hearing voices, delusions)

24

What is characteristic of Bipolar Depression 3?

Suicide happens in this phase

Hypothyroidism (may result from Lithium use)

Symptoms similar to depression

Alcohol use may start during this phase

25

What are the side effects of using Lithium to treat bipolar disorder?

LMNOP

Lithium side effects:

Movement (tremor)

Nephogenic diabetes insipidus

HypOthyroidism

Pregnancy problems

26

What is characteristic of Bipolar Depression 4?

Most patients have more depression than mania

Depression more debilitating

Treatment more difficult for depression

Antidepressant use can push depression into mania

27

What is Cyclothymic Disorder?

Presence of hypomanic symptoms for at least 2 years that don't meet criteria for full hypomanic episode and numerous periosds of depressive symptoms that don't meet criteria for full major depressive episode

Results in distress or functional impairment

Chronic, smoldering form of bipolar illness (not as severe as bipolar but can progress to it)

28

What is the treatment plan for patients with addiction and bipolar disorder?

Must treat addiction and mood disorder

Often harder to treat than those with only bipolar

29

What is the Mania Criterion A in DSM5?

A distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistent increased goal directed activity or energy - lasting 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)

30

What is the Mania Criterion B in DSM5?

Inflated self esteem or grandiosity

Decreased need for sleep

Distractability

More talkative than usual, with pressured/rapid speech

Flight of ideas or racing thought

Increased goal directed behavior or agitation

Excessive involvement in pleasurable activities (sex, cars, money) that may have painful results

31

What is a good mnemonic for mania diagnosis during a mental status exam?

DIGFAST (must have at least 3 of 7 symptoms)

Distractible

Increased activity/psychomotor agitation

Grandiosity/Superhero mentality

Flight of ideas or racing thought

Activities that are dangerous or hypersexual

Sleep decreased

Talkative or pressured speech

32

What are some soft signs of mania?

Large hats on men

Multiple rings on men

Excessive visible cleavage on women or exposed chest on men

Public nudity

Public masturbation

33

Compare the Bipolar disorder types and cyclothymic disorder.

Bipolar I - Manic episode (see psychosis or need hospitilization), with or without episode of major depression

Bipolar II - Major depressive episodes & hypomanic episodes

Cyclothymic Disorder - Hypomanic and depressive episodes for at least 2 years that don't meet criteria of full hypomanic or depressive episodes

34

What is the difference between mania and schizophrenia?

Mania thoughts are often disorganized, abundant, elaborate, and sometimes playful

Schizophrenia thoughts are more bland, fragmented, bizarre with affect less intense

35

What is kindling?

Like a seizure disorder (once you have one, the easier is is to have another)

Low levels of electrical impulses that start with no effect, then seizures in response to the same impulse